Criminal and Juvenile Justice

SAMHSA promotes early intervention and treatment as healthier alternatives to detaining people with behavioral health conditions in U.S. justice systems.

Overview

Many individuals who come in contact with law enforcement and the criminal or juvenile justice systems have a mental and/or substance use disorder. According to a 2006 Bureau of Justice Statistics report, approximately 74% of state prisoners, 63% of federal prisoners and 76% of jail inmates met the criteria for a mental health disorder. An estimated 42% of state prisoners and 49% of jail inmates met the criteria for both a mental health and substance use disorder. Studies have found that for youth in the juvenile justice system, 50% to 70% met criteria for a mental disorder and 60% met criteria for a substance use disorder. Of those youth with co-occurring mental and substance use issues, almost 30% experienced severe disorders that impaired their ability to function.

According to a 2011 report from SAMHSA’s Treatment Episode Data Set (TEDS), the criminal justice system was the major source of referrals to substance use treatment, with probation or parole treatment admissions representing the largest proportion of criminal justice system referrals. Most probation or parole admissions were males between the ages of 18 and 44. The most common substances reported by these referrals were alcohol, marijuana, and methamphetamine. Similarly, in SAMHSA’s adolescent substance abuse treatment grant programs, juvenile justice is the most frequent referring agency.

An estimated 14% of men and 24% of women in jails have a serious mental illness (SMI) such as bipolar disorder or schizophrenia. Treatment for SMI in incarcerated settings is both costly and challenging. Moreover, people with mental illness may remain incarcerated longer than those without mental illness. For example, a 2012 study of New York inmates (PDF | 717 KB) found that people with mental illness remained incarcerated nearly twice as long as other inmates.

Most people with mental illnesses are not violent, and most violent crimes are not committed by people with mental illnesses. According to SAMHSA’s National Survey on Drug Use and Health (NSDUH), approximately 5% of the American population has an SMI. SMI is generally defined as a mental or behavioral disorder that results in serious functional impairment, such as schizophrenia, major depressive disorder, and bipolar disorder. Only 3% to 5% of violent acts are attributable to people with SMI. Researchers have found the prevalence of violence among those with a major mental disorder who had received treatment and did not abuse substances was indistinguishable from people in a non-substance abusing comparison group. People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. In fact, people with SMI are more than 2.5 times more likely to be attacked, raped, or mugged than the general population. One study found that those with SMI are 11 times more likely to be the victim of a violent crime than the general population.

Finding their way to treatment services can be a difficult process for people struggling with addiction, but it is especially difficult for those arrested and entering the criminal justice system. According to the Office of National Drug Control Policy, only 4 in 10 offenders needing treatment reported receiving treatment services while incarcerated. Among those who do receive treatment, the quality of those services varies from state to state.

Upon release from incarceration, individuals with behavioral health issues face many barriers to successful reentry into the community, such as lack of health care, job skills, education, and stable housing, and poor connection with community behavioral health providers, which may jeopardize their recovery and increase their probability of relapse and re-arrest. Individuals leaving correctional facilities often have lengthy waiting periods before attaining benefits and receiving services in the community. Progress has been made in some state correctional systems, which now suspend rather than terminate benefits such as Medicaid or Social Security, while individuals are incarcerated, and then immediately restart their benefits post-release. However, waiting periods and termination of benefits have devastating effects on the lives of offenders who need to connect with treatment providers to maximize the likelihood of recovery and prevent re-incarceration. These barriers are especially challenging for minority groups, which rank highest among the uninsured and are disproportionately represented in the criminal and juvenile justice systems.

To reduce the human and fiscal cost and consequences of repeated arrests and incarceration for people with behavioral health issues, improved access to behavioral health and other support services must be made available to individuals involved in the criminal and juvenile justice systems. With its justice and law enforcement partners, SAMHSA addresses these issues through a variety of mechanisms:

Grant programs

Policy academies

Training and technical assistance

Experts’ meetings

Product development

The overarching theme of SAMHSA’s work is to support treatment and recovery efforts through evidence-based and best practices in diversion and reentry. These practices are implemented on a robust platform of cross-system behavioral health and justice collaboration. SAMHSA approaches the work through:

Identification of individuals with mental and substance use disorders

Pre- and post-adjudication using evidence-based screening and assessment to ensure comprehensive treatment, supports, and services

Diversion of individuals from the justice system into home- and community-based treatment

Using evidence-based and promising practices demonstrated to be less costly and more successful than treatment provided in confinement settings

Provision of training and technical assistance for law enforcement officers, juvenile and family court judges, probation officers, and other judicial decision-makers

Assurance of equity of opportunities for diversion and linkage to community services and supports for all populations in order to decrease disproportionate minority contact with the justice system